原发性肝癌立体定向消融放疗后CT影像学随访观察  

CT appearances of primary hepatic carcinoma after stereotactic ablative radiotherapy

作　　者：郝光远[1] 庞军[2] 陈燕[2] 魏丛全 黎雪琴[1] 

机构地区：[1]武警湖北总队医院放射科,湖北武汉430061 [2]武警湖北总队医院伽玛刀中心,湖北武汉430061

出　　处：《临床军医杂志》2014年第4期393-395,398,共4页Clinical Journal of Medical Officers

摘　　要：目的观察原发性肝癌全身γ刀立体定向消融放疗（SABR）后的CT影像学表现。方法随机选取采用超级γ刀（SGS-I型）SABR的肝癌患者100例，将112个可评价病灶按肿瘤大小分为三组：A组，肿瘤最大径〈5cm；B组，肿瘤最大径5—10cm；C组，肿瘤最大径〉10cm。治疗后2—3个月及半年CT复查，分析不同类型和大小肿瘤治疗后的CT平扫及增强影像特点。结果肝癌γ刀治疗后2—3个月CT复查，与治疗前比较，A组病灶缩小不明显，无统计学差异（t=1．51，P〉0．05），B、C组病灶明显缩小，差异有统计学意义（t=10．07、8．56，P均〈0．05）。增强扫描，所有病灶边缘均与治疗靶区形状基本一致，清晰可见。其中27（24．11％）个病灶动脉期及门脉期均无明显强化，30（26．79％）个病灶边缘动脉期出现环形强化，门脉期强化仍可见，但减弱，55（49．11％）个病灶动脉期边缘强化，门脉期强化较动脉期明显，延迟期强化仍可见。治疗半年后所有边缘强化均减弱或消失，变得模糊。结论肝癌γ刀治疗后CT影像表现具有多样性，需结合临床，AFP检查方可作出客观评价。Objective To study the appearances of primary hepatic carcinoma in CT imaging after stereotactic ablative radiothera- py. Methods In 100 patients with primary hepatic carcinoma who would undergo stereotactic ablative radiotherapy by Super-Gam- ma-Knife, 112 lesions were divided into Group A （ maximal diameter less than 5 cm） , Group B （ maximal diameter 5 - 10 era） and Group C （ maximal diameter over 10 cm） based on the tumor size. They were followed up after treatment for 2 - 3 months and half a year. Results There was no significant reduction in CT in Group A after 2 - 3 months＇ treatment （ t = 1.51, P 〉 0.05 ）. The tumors reduced more sharply in Group B and C than in Group A （t = 10.07, t = 8.36, P 〈 0.05 ）. In enhanced CT, there were three appearances, i.e. low density in 27 （24.11% ） lesions, ring-shaped enhancements in 30 （26.79%） lesions （in portal ve- nous phase the appearance could still be seen） and ring-shaped enhancements in 55 （49.11% ） lesions in the triple-phase CT ima- ging appearance. After treatment for half a year, all the marginal enhancements decreased or disappeared. Conclusion There are different CT image appearances in patients with primary hepatic carcinoma after stereotactic ablative radiotherapy with Super-Gam- ma-Knife. Dynamic CT imaging to evaluate its curative effect is reliable, if combined with clinical examination.

关 键 词：肝肿瘤 立体定向消融放疗 全身伽玛刀 电子计算机断层摄影 

分 类 号：R816.5[医药卫生—放射医学]